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Saturday, 31-Jul-2010
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New household registration
New household registration
New household registration
Details
Applicant Details
In order to complete an application to join the Housing Register
Complete your household details below
You will then be provided with a reference number
Once you have your reference number, follow the link at the bottom of the page - To apply for Housing Register application please click here
Title:*
**Please Choose**
Dr
Master
Miss
Mr
Mrs
Ms
Other
Professor
Reverend
First name:*
Family name:*
Has this applicant ever been known by any other names, E.G a maiden name - if so, please provide details:
Address 1:*
Address 2:*
Address 3:
Address 4:
Postcode:*
Date moved in to this address:*
(dd/mm/yyyy)
Home telephone:
Work telephone:
Mobile telephone:
Email:
National Insurance Number:
Date of birth:*
(dd/mm/yyyy)
Gender:*
**Please Choose**
Female
Male
Unknown
Ethnic Origin:
**Please Choose**
Asian or Asian British Bangladeshi
Asian or Asian British Indian
Asian or Asian British Other
Asian or Asian British Pakistani
Black or Black British African
Black or Black British Caribbean
Black or Black British Other
Chinese
English Gypsy/Romany
Irish Traveller
Mixed White and Asian
Mixed White and Black African
Mixed White and Black Caribbean
Other Ethnic Group
Other Mixed
Prefer not to answer
White British
White Irish
White Other
Is this household member pregnant?
yes
no
If yes, when is the baby due?
(dd/mm/yyyy)
Does this household member have a disability:
**Please Choose**
Yes
No
Nationality:
**Please Choose**
Any other country
Bulgaria
Czech Republic
Estonia
Hungary
Latvia
Lithuania
Non EEA Nat
Other European Economic Area (EEA Nat) country
Poland
Refused
Romania
Slovakia
Slovenia
UK national resident in UK
UK national returning from residence overseas
Are you a councillor, board member or employee of any of the partner organisations?
yes
no
If yes, please give details:
Are you related to a councillor, board member or employee of any of the partner organisations?
yes
no
If yes, please give details:
Do you have any pets?
yes
no
If yes, please give details:
Have you or anyone moving with you ever had any action taken against you due to anti social behaviour?
yes
no
If yes, please give details:
Do you or anyone moving with you have any outstanding criminal charges or has any previous police action been taken?
yes
no
If yes, please give details:
Have you ever been convicted of a criminal offence?
yes
no
If yes, please give details:
Child access:
yes
no
Child access details:
Are you employed ?
yes
no
Job title:
Employer's name:
Employer's address:
Income:
Current landlord
If you rent your home, please state the name of your landlord?
**Please Choose**
Accent Foundation – North East
Anchor
Broadacres Housing Association
Coast & Country
Darlington Borough Council
Darlington Housing Association
Endeavour Housing Association
English Churches Housing Group (ECHG)
Erimus Housing
Guinness Northern Counties
Habinteg Housing Association
Hanover
Hartlepool Borough Council
Home Group
Home Prime
Housing 21
Housing Hartlepool
Middlesbrough Council
Nomad E5
Other landlord
Places for People
Private landlord
Railway Housing Association
Redcar & Cleveland Borough Council
Salvation Army Housing Association (SAHA)
Stockton on Tees Borough Council
Three Rivers Housing Group
Tristar Homes
Two Castles Housing Association
William Sutton Homes
Which local authority do you live in? (If you live outside of the Tees Valley, which local authority within the sub region would you like to live in?):*
**Please Choose**
Darlington Borough Council
Hartlepool Borough Council
Middlesbrough Council
Redcar & Cleveland Borough Council
Stockton on Tees Borough Council
Contact address
Same address as main applicant:
yes
no
If yes, then please ignore the following address fields
Address line 1:*
Address line 2:*
Address line 3:
Address line 4:
Postcode:*
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